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Onay T, Çelen ZE, Bayhan M, Kandemir İ, Kiliç NC, Kayaalp ME. A More Conservative Approach in the Surgical Management of Pediatric Physeal Ankle Fractures Should be Preferred: Mid to Long-term Functional Outcomes of Three Different Surgical Techniques for Salter-Harris Type II and Triplane Distal Tibial Fractures. J Pediatr Orthop 2023; 43:e734-e741. [PMID: 37470086 DOI: 10.1097/bpo.0000000000002471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
BACKGROUND Pediatric physeal ankle fractures carry a high risk of complications. This study aimed to (1) investigate the effect of anatomic reduction of the physis on mid to long-term functional outcomes in Salter-Harris type II and triplane distal tibial physeal fractures (DTPFs) and (2) compare the outcomes of 3 different surgical techniques applied in these fractures. METHODS The database of a single level-I trauma center was retrospectively reviewed for DTPFs between 2012 and 2022. A total of 39 eligible patients with operative Salter-Harris type II and triplane fractures between 2012 and 2022 were included. Surgical treatment methods were closed reduction-percutaneous fixation (CR-PF), open reduction-screw fixation, or open reduction-plate fixation. Patients were further divided into subgroups for fractures reduced anatomically (<1 mm) or nonanatomically (1 to 3 mm). The primary outcome measures were the American Orthopaedic Foot and Ankle Society Score, ankle range of motion, presence of premature physeal closure and angular deformities, and Takakura ankle osteoarthritis grade. RESULTS A total of 39 patients were included, with an average age of 12.9 ± 2.2 years. The mean follow-up time was 68.9±38.0 months. The CR-PF group had higher postoperative fracture displacement ( P = 0.011). American Orthopaedic Foot and Ankle Society scores were excellent in all groups, statistically similar between surgical techniques, and similar between anatomic and nonanatomic reduction groups. The CR-PF group ( P =0.030) and nonanatomic reduction ( P = 0.030) provided a significantly lower ankle osteoarthritis rate. All 4 patients with premature physeal closure were observed in patients treated with open techniques. CONCLUSIONS CR-PF for the treatment of DTPFs should be preferred in suitable cases as it is less invasive and provides satisfactory mid to long-term functional outcomes without increasing complications compared with anatomic reduction and open techniques. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Tolga Onay
- Department of Orthopaedics and Traumatology, Göztepe Training and Research Hospital, Istanbul Medeniyet University
| | - Zekeriya Ersin Çelen
- Department of Orthopaedics and Traumatology, Kartal Dr. Lütfi Kirdar City Hospital, University of Health Sciences, Istanbul
| | - Mazlum Bayhan
- Department of Orthopaedics and Traumatology, Yalova State Hospital, Yalova, Turkey
| | - İbrahim Kandemir
- Department of Orthopaedics and Traumatology, Yalova State Hospital, Yalova, Turkey
| | - Nazim Canberk Kiliç
- Department of Orthopaedics and Traumatology, Yalova State Hospital, Yalova, Turkey
| | - Mahmut Enes Kayaalp
- Department of Orthopaedics and Traumatology, Yalova State Hospital, Yalova, Turkey
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Tang Z, Xiang F, Arthur V DT, Xiao S, Wen J, Liu H, Li X, Fang K, Zeng M, Cao S, Li B, Gong H, Li F. Comparison of mid-term clinical results between lag screw fixation and Kirschner wire fixation after close reduction in adolescent triplane distal tibia epiphyseal fracture. Foot Ankle Surg 2022; 28:1440-1443. [PMID: 35999112 DOI: 10.1016/j.fas.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 08/03/2022] [Accepted: 08/14/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To compare the mid-term clinical results of lag screw and Kirschner wire fixation(KWF) for close reduction in triplane distal tibia epiphyseal fracture. METHODS A retrospective analysis of 25 cases of triplane fractures of the distal tibia treated in our department from Jan 2017 to Dec 2019 was performed, Lag screw fixation(LSF) was used in 14 cases and Kirschner wire fixation in 11 cases, the clinical results were evaluated by premature epiphyseal closure(PPC) rate, the American Orthopaedic Foot and Ankle Score (AOFAS) Ankle-hindfoot foot scoring system, the lateral distal tibial angle (LDTA) from X-ray. RESULTS All the 25 children were followed up for a mean of 34(ranging 26-52) months. AOFAS scores improved from a mean of 33(ranging 29-43) pre-op, to 82(ranging 77-88) at three month follow up, to 92 (ranging 88-98) at last follow-up in all 25 cases. Till last follow up there was no cases premature physeal closure in LSF group but 4 cases in KWF group, LDTA in both groups at last follow up shows no ankle varus or valgus deformity, and the ankle joint function was not limited in all cases. CONCLUSION Lag screw and Kirschner wire fixation methods can both achieve good clinical effects for triplane distal tibia epiphyseal fracture. Lag screw fixation provide lower PPC rate but Kirschner wire fixation save one anesthesia and surgery.
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Affiliation(s)
- Zhongwen Tang
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha 410005, China
| | - Feng Xiang
- Department of Traumatic Orthopedics, Zhuzhou Central Hospital, the Affiliated Zhuzhou Hospital of Xiangya medical college, Central South University, Zhuzhou 412007, China
| | - Djandan Tadum Arthur V
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha 410005, China
| | - Sheng Xiao
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha 410005, China.
| | - Jie Wen
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha 410005, China; Department of Human Anatomy, Hunan Normal University School of Medicine, Changsha, Hunan 410013, China.
| | - Hong Liu
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha 410005, China
| | - Xin Li
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha 410005, China
| | - Ke Fang
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha 410005, China
| | - Ming Zeng
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha 410005, China
| | - Shu Cao
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha 410005, China
| | - Bo Li
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha 410005, China
| | - Haoli Gong
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha 410005, China
| | - Fanling Li
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha 410005, China
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Blondin E, Stourbe O, Plancq MC, Deroussen F, Gouron R, Klein C. Outcomes of pediatric distal tibial physeal fractures. Orthop Traumatol Surg Res 2022; 108:103199. [PMID: 35031515 DOI: 10.1016/j.otsr.2022.103199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/10/2021] [Accepted: 05/20/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Fractures of the distal tibia involving the physis are relatively common in children. The data reported on long-term complication rates vary between studies. HYPOTHESIS Pediatric distal tibial fractures cause medium- and long-term growth disturbances. MATERIALS AND METHODS This was a retrospective single-center study. We included physeal distal tibial fractures that were treated in the operating room with a minimum 12-month follow-up. The analysis included age, gender, weight status, circumstances and energy of the injury, fracture type, subsequent treatment, complications, duration of follow-up, radiologic findings and functional outcomes using the AOFAS. RESULTS A total of 46 patients were included with a mean age of 12.8 years (2.4-15.9 years) and a mean follow-up of 35.8 months (12-119). At the longest follow-up, 7 patients (15.2%) had growth disturbances. The mean AOFAS score was 95/100 and a decreased ankle range of motion was observed in 18 patients, but it was always less than 10°. High-energy injuries (20 patients) resulted in worse clinical outcomes and a significantly higher rate of growth disturbances (p=.03). DISCUSSION This study confirmed the presence of growth disturbances following pediatric distal tibial fractures, especially in cases of high-energy trauma. Therefore, these fractures should be monitored until the end of the growth period. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Emile Blondin
- Service d'Orthopédie et Traumatologie pédiatrique, CHU Amiens-Picardie, Groupe Hospitalier Sud, 80054 Amiens Cedex 1, France
| | - Olivier Stourbe
- Service d'Orthopédie et Traumatologie pédiatrique, CHU Amiens-Picardie, Groupe Hospitalier Sud, 80054 Amiens Cedex 1, France
| | - Marie-Christine Plancq
- Service d'Orthopédie et Traumatologie pédiatrique, CHU Amiens-Picardie, Groupe Hospitalier Sud, 80054 Amiens Cedex 1, France
| | - François Deroussen
- Service d'Orthopédie et Traumatologie pédiatrique, CHU Amiens-Picardie, Groupe Hospitalier Sud, 80054 Amiens Cedex 1, France
| | - Richard Gouron
- Service d'Orthopédie et Traumatologie pédiatrique, CHU Amiens-Picardie, Groupe Hospitalier Sud, 80054 Amiens Cedex 1, France
| | - Céline Klein
- Service d'Orthopédie et Traumatologie pédiatrique, CHU Amiens-Picardie, Groupe Hospitalier Sud, 80054 Amiens Cedex 1, France.
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Comparison of K-wire versus screw fixation after open reduction of transitional (Tillaux and triplane) distal tibia fractures. J Pediatr Orthop B 2021; 30:443-449. [PMID: 33165213 DOI: 10.1097/bpb.0000000000000830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Our study aimed to compare the clinical and radiographic outcomes of transitional distal tibia fractures treated with K-wire fixation versus screw fixation after open reduction. A retrospective study was performed on all displaced transitional distal tibia fractures that underwent operative fixation. Following open reduction, surgical fixation was performed using either percutaneously inserted 2.0 mm K-wires, or 4.0 mm partially-threaded cannulated cancellous screws. Clinical and radiographic outcomes between the two groups were assessed using the modified Weber score. Other outcome measures assessed were surgical time, casting duration, follow-up duration and duration before return-to-sports. We recruited 49 patients with transitional distal tibia fractures requiring open reduction and surgical fixation. There were 18 patients in the K-wiring group (KWG), and 31 patients in the screw fixation group (SFG). All patients in both groups had excellent clinical and radiographic outcome based on the modified Weber's scoring, full radiological healing, and no residual displacement upon final follow up. The KWG had significantly shorter surgical time (41.0 min versus 75.1 min, P < 0.0001) and shorter follow-up duration needed before discharge (5.4 months versus 8.7 months, P = 0.024). However, they required a longer post-operative casting duration (7.3 weeks versus 5.3 weeks, P = 0.006). No significant difference was found for the duration before return to sports between both groups. Complications were few in this study group. Superficial pin site infection was noted in one patient in the KWG, and valgus deformity of the ankle was noted in one patient in the SFG. In our study, surgical treatment of transitional distal tibia fractures demonstrated equally excellent outcomes when treated by open reduction with either K-wire or cannulated screw fixation. Level of evidence: III.
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Abstract
INTRODUCTION Paediatric ankle fractures represents about 5% of all paediatric fractures. It is the most common physis to be injured in the lower limb accounting to approximately 15-20% of all physeal injuries. This article reviews the literature on this common injury which still has many controversial areas and gives guidelines to management based on the existing evidence along with clinical experience gained from a Level I trauma center. CLASSIFICATION The original Salter-Harris Classification with the additional types is a good system to guide on the management. The transitional fractures form a separate group with technically two broad types-biplane and triplane injuries. Though there are many sub-types in this group with some popular eponymous fractures, the treatment principles remain the same. MANAGEMENT A very low threshold for CT scan is recommended when there is a clinical suspicion of fracture with a negative radiograph or an intra-articular fracture in the radiograph especially in the adolescent age group. CT scan helps in accurate quantification of the intra-articular displacement and also helps to comprehend the fracture geometry better. All the intra-articular fractures with displacement > 2 mm need perfect anatomical reduction and stabilization. Assisted closed reduction and percutaneous fixation along with arthrogram to confirm articular congruity is acceptable as long as the reduction is perfect. Irrespective of the method of treatment, in children with more than 2 years of growth remaining it is important to counsel regarding the high incidence of pre-mature physeal closure and the need for regular follow-up.
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